Have we been doing it all wrong? The role of “super-especialists”
doctors in COVID-19 pandemic and Medicine 4.0 era.
Gustavo Pampolha Guerreiro MD, Valdano Manuel MD, Lucas Figueredo
Cardoso MD
Department of Cardiovascular Surgery, Instituto do Coração do Hospital
das Clínicas da Faculdade de Medicina da Universidade de São Paulo
(InCor-HCFMUSP) - São Paulo, Brazil.
Corresponding author: Gustavo Pampolha Guerreiro - Heart Institute
(Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade
de São Paulo, São Paulo, Brazil, Av. Dr Enéas de Carvalho Aguiar, 44 –
Pinheiros, Sao Paulo - Brazil.
Email: gustavo_guerreiro@hotmail.com
Telephone: +5511998347107
Conflicts of interest: None declared
Funding: None
Word count: 1014
Keywords: COVID-19; Medicine 4.0; Pandemic.5
Since the beginning of the teaching process in modern medical schools,
the evolution of medicine brought up the need for medical education to
also evolve. We passed through the ages of the theaters where surgeries
and lectures were performed and the teachers were the main source of
knowledge until today with technology, simulation-learning, and
evidenced-based medicine when information comes from multiple sources so
it is important is to filter to achieve reliable
conclusions.1-3
Medicine evolution also allowed us to confirm and refute hypotheses,
discover new drugs and technologies, understanding better the
pathophysiology, and consequently adequate treatment of many diseases.
Thus the knowledge has been increased in all medical areas, and it
required doctors to study more specific subjects to better understand
its implications. That way, traditionally recognized areas in medicine
originated subareas of knowledge capable of generating more hypothesis
and developing higher quality evidence.4,5
As so, the referral of patients to specialized doctors in subareas of
medicine became the gold standard of patient care. However, most of the
time, one patient needs an approach from different specialized doctors,
who - unfortunately - do not interchange their expertise to
individualize one’s treatment and therefore do not give the best care to
the patients.6
Furthermore, globalization has affected medicine and health care systems
to a great degree. While in the past centuries it could took almost one
year for an infectious disease spread across continents - as seen in the
influenza epidemic -, we have recently seen the outbreak of Coronavirus
Disease 2019 (COVID-19) escalate to a pandemic within five months
hitting over 212 countries.4 Suddenly many specialist
doctors found themselves in a situation they had not faced for a long
time: having to treat patients out of their subarea of expertise. The
possibilities of teaching and learning through the modality of webinars
brought to these days the urgent need for teamwork and interdisciplinary
approach for patient care, taking advantage of multiple areas of
knowledge.7,8
The question is: have we been doing it all wrong when we have become
“super-specialists”? We think not! With the exponential increase in
the quantity of available information and the speed at which data can be
accessed and analyzed, it is impossible to be aware of every new content
in all medical areas. The lesson that COVID-19 pandemic brought to us
was the urgent need for the interdisciplinary approach to treating
better our patients, and not only each individual disease that they
present. Even though this concept is not new, in the current era, it
became difficult to find teamwork in medicine. The Heart Team
(multidisciplinary approach for cardiovascular disease patients) is a
great example regarding this issue. Experts have been proposing teamwork
as the gold standard to establish a better strategy to treat a complex
cardiovascular disease patient, however, the effective Heart Team
implantation around the world remains a challenge.9,10
Telemedicine during the COVID-19 era taught us so much. We must review
our traditional approach to medical students, residents, colleagues, and
patients in which we became stuck to distance and time obstacles. We
must use the technology on our behalf to offer the best treatment and
follow-up for patients. We live now in the Medicine 4.0
era.12 As Darwin a long time ago proved: we must
evolve!
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